Volunteer Application

Volunteer Opportunities

Please indicate the days and times you are usually available to volunteer

Sun

Mon

Tues

Wed

Thu

Fri

Sat

Morning:

Afternoon:

Evening:

My availability is

From

To

Children's Hospital Volunteer (Sanford Medical Center)

Coffee Corner Volunteer (Sanford Medical Center)

Crafts/Tray Favors (Sanford Medical Center)

Crocheters (Sanford Medical Center)

Flower Delivery (Sanford Health)

Gift Shop Volunteer (Sanford Medical Center)

Infusion Room Volunteer (Sanford Medical Center)

Knitters (Sanford Medical Center)

Lobby Greeter Host/Hostess (Sanford Medical Center)

Mail Volunteer (Sanford Medical Center)

Outpatient Surgery Center (Sanford Medical Center)

Pet Therapy (Sanford Medical Center)

Piano (Sanford Medical Center)

Radiology Volunteer (Sanford Medical Center)

Personal Information

First Name

Last Name

Address

City

State

Zip

Email

Phone

Gender

Date of Birth

How would you like us to contact you?

Email
Phone

Do you belong to the Retired Senior Volunteer Program?

Yes
No

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relationship

Education & Skills

EducationLevel

High School
Some College
College Graduate

If current student, College attending

Area of study

Year in School

Previous volunteering

Special training, skills, or experience

Current employer

Have you even been employed by Sanford Health or its affiliates?
Yes
No

If yes, please include job title, service or department and different names (if used)?

References

Reference 1

Name

Address

Phone

Reference 2

Name

Address

Phone

Reference 3

Name

Address

Phone

Complete And Submit

Why do you want to volunteer?

Have you ever been convicted of a crime?
Yes
No

Where, when, nature of offense, and disposition

I understand and agree that in the performance of my duties as a volunteer at Sanford Medical Center, I must hold patient information in confidence. Hospital volunteers have an ethical responsibility to protect patient's privacy. Information regarding patients must not be released, disclosed, or discussed either inside or outside the hospital.

There are laws, both state and federal, safeguarding patient records and penalties for the release of confidential information without patient authorization. I understand all may result in punitive action including possible termination, fine or imprisonment.

As a volunteer, I will consider all confidential information that I hear about patients, families or hospital personnel as private. I will preserve family privacy by refraining from questioning staff, children or families about a patient's diagnosis. I will not discuss a patient's medical condition unless the patient or family initiated a discussion.

I certify that the information given by me in this application is true and complete. I understand that any false information, misrepresentation or concealment of fact is sufficient ground for my immediate discharge by Sanford.

I understand and agree that all information furnished in this application may be verified by Sanford. I hereby authorize all individuals and organizations named or referred to in this application and any records repository, or law enforcement organization, to give Sanford all information relative to my employment, work habits, character, credit history and any criminal record and hereby release such individuals, organizations and Sanford from any liability for any claim or damage which may result. I understand that I may inquire as to the identity of those credit reporting agencies contacted and Sanford will advise me of their identity and the nature and scope of information furnished.

I understand upon agreement of this application I will receive an electronic background check and am responsible to complete and return the background check within 48 hours.

I understand and agree that my volunteer services can be terminated with or without cause and without notice at any time at the option of with Sanford or myself. I also understand that volunteers must be at least 17 years of age and that volunteers must wear a volunteer uniform and badge while on duty.

Sanford is an Equal Opportunity Employer and expressly prohibits any form of unlawful volunteer harassment based on race, color, religion, gender, sexual orientation, national origin, age, disability or veteran status. If you have questions or need further assistance, please contact Sanford Volunteer Services at (701)234-5940.